Chipped Teeth

When a patient presents with a chipped or fractured tooth, the first step is to determine the extent of the damage.

A patient with a minor or incomplete fracture will present complaining of tooth pain on chewing or sensitivity to cold.

Minor fractures are relatively easy to treat, but the proper diagnosis must be made and other possible causes for tooth pain ruled out, including a fractured or lost restoration ("filling") and pulpitis (reversible and irreversible).

The tooth may have a crack without the loss of tooth structure and still be basically intact, like a greenstick fracture.

Using a penlight (transillumination), check for a crack in the tooth. See if the fracture extends below the tissue

• Your patient complains of sudden pain with chewing. 

• You examine his teeth and discover what appears to be a minor fracture of a posterior tooth. 

• Either fill the tooth or apply stomahesive. 

• Either way, you are preventing mechanical stimulation of the dentin, which is the source of pain.

Major Fractures

Like a minor fracture, the goal in treatment is to alleviate the pain by preventing stimulation of the dentin.

If the pulp has been exposed, you must NOT use IRM (Intermediate Restorative Material) or any other substance with eugenol to seal the tooth. The eugenol will kill the pulp. Seal a pulp-exposure with Dycal or another calcium hydroxide product first, then apply IRM.

If only the dentin has been exposed, seal the fracture with IRM made of zinc oxide and eugenol.

Stomahesive Application

Cut the Stomahesive to the desired length.

Apply to the area needing support.

Inspect to assure proper splinting.

From "Dental Emergencies" Volume 803673 DN
Naval School of Health Sciences, December, 1995

For additional information, read:

"Dental Emergencies" in the General Medical Officer Manual.

"Oral Diseases and Injuries" in the Hospital Corpsman 1 and C Manual.

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